A 28-yo smoker was admitted with sudden onset of dyspnea while walking. She had absent breath sounds on the left with a hyperresonant chest. After getting a chest x-ray, the ED resident inserted a size 32F tube and connected it to a water seal. An hour later the patient complained of severe shortness of breath, cough and her pulse oximeter revealed oxygen saturation of 89%. A portable chest x-ray was done and is shown below. She was admitted to the ICU and placed on the ventilator because of severe respiratory distress. How could this condition have been prevented?
A. Thoracostomy in the operating room
B. Remove air slowly with intermittent clamping of the tube
C. Administer IV fluids at the same time as air is withdrawn from the chest
D. Remove a maximum of 750 cc per day
E. Always insert a small size chest tube
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Re-expansion pulmonary edema is a rare complication that occurs when there is rapid evacuation of fluid or air from the chest cavity
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The condition is not common but when it occurs, it can result in high mortality
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The cause is believed to be due to the sudden drop in pleural pressure after removal of the air or fluid
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The condition is most likely to occur in young patients with large pneumothorax or those with lung collapse of more than 7 days’ duration.
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To prevent this condition, no more than 1800 ml of fluid should be removed at one time and the pneumothorax should be gradually evacuated with intermittent clamping
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Any time the patient develops a cough or dyspnea, the procedure should be interrupted.